General Surgery

Splenic Disease

There are a variety of diseases that affect the spleen and can cause destruction of blood cells, platelets or red cells. ITP, or immune thrombocytopenic purpera, is a disease which destroys platelets and can lead to bleeding problems. If not controlled by medication, splenectomy is highly effective at curing this disease. Hereditary spherocytosis destroys red blood cells and also responds well to splenectomy. A variety of other disorders of the spleen can respond or require splenectomy. Laparoscopy is ideally suited to this operation especially if the spleen is of normal or reduced size although even enlarged spleens can be removed this way. The recovery is quicker and easier than with open surgery and generally involves minimal blood loss and low complication rates.

Adrenal Disease

Diseases of the adrenal gland are fairly rare but can lead to very significant illnesses, including cancer. Laparoscopic removal of the adrenal gland can be done effectively and safely through several small incisions. Conversely, the open operation either involves a long abdominal incision or one through the back or flank, including the removal of a rib. It has become the gold standard operation for adrenal tumors in many institutions worldwide.

Inguinal Hernia

Laparoscopy offers a very effective and less invasive alternative to the traditional type of inguinal hernia repair. For a traditional repair, an incision is made in the groin, the hernia sac is removed or reduced (pushed back in), and the defect is repaired either with sutures or with mesh. Healing generally takes 2 to 6 weeks depending of the extent of the hernia and the type of repair. The laparoscopic repair also removes or reduces (pulled back in) the hernia sack and then places the mesh behind the abdominal wall muscles rather than on top of them as with the open repair. This allows the abdominal cavity to seal the mesh against the abdominal wall and allows for an almost immediate ability to perform full activities with no mandatory waiting period. The laparoscopic incisions are smaller and tend to cause less pain which also facilitates a quicker recovery. This is an excellent choice for persons who need a rapid return to work or to strenuous physical activity. It is also a good option for the repair of recurrent and bilateral (both sides) hernias. In the case of a recurrent hernia, the laparoscopic repair avoids the scar tissue from the previous operation(s) which can be problematic both in identifying the important structures and in finding good tissue to use for the hernia repair. In persons with bilateral hernias, laparoscopic repair of both sides can be performed at one setting utilizing the same three small incisions and generally adds very little additional time to the procedure. The incidence of complications following laparoscopic hernia repair is similar to that of the traditional open repair, and as experience grows, actually may be less, including a very low rate of recurrence.

Paraesophageal Herna

This is a rare but serious condition in which the stomach (and occasionally other abdominal organs) pushes up, or herniates, through an abnormally enlarged opening in the diaphragm into the chest cavity. This is considered a type of hiatal hernia, but it is one that can cause far more serious symptoms and consequences than those of the common hiatal hernia which is generally associated only with heartburn. The symptoms of a paraesophageal hernia can range from trouble swallowing to severe chest pain following a meal. Regurgitation of food, heartburn, chronic blood loss and even strangulation of the stomach can occur. The traditional operation involves either a long incision through the chest or one through the abdomen or sometimes both. Usually, persons with this problem are elderly and have a variety of medical problems making major surgery risky. Laparoscopic repair of paraesophageal herniae is a minimally invasive procedure and offers a lower incidence of complications, a shorter hospital stay, and a quicker and less painful recovery. The repair involves pulling the stomach back down into the abdomen, removing the hernia sac, narrowing the opening in the diaphragm and usually fixing the stomach to the diaphragm.

Laproscopic Cholecystectomy

Laparoscopic cholecystectomy is a minimally invasive surgical procedure used to treat gallbladder disease by removing the gallbladder with the aid of a laparoscope. The surgery is performed under general anesthesia. Almost routinely the patient returns home on the day of surgery with minimal associated discomfort. The procedure affords a return to normal activities considerably earlier than the traditional “open” gallbladder surgery.

Patients with gallbladder disease usually present with symptoms of indigestion, bloating, intolerances to certain foods, and pain or discomfort in the upper mid abdomen and right upper abdomen.

The decision to perform cholecystectomy is made after a sonogram or ultrasound of the gallbladder confirms the presence of gallstones, infection, or obstruction of the gallbladder.

The procedure begins by the surgeon making several very small incisions on the abdomen. The laparoscope, which is both a fiber optic light source and video camera, is actually a small tubular instrument which is inserted into the abdomen through one of the incisions. The other incisions are used for operating instruments. A small amount of carbon dioxide is used to temporarily inflate the abdomen for improved visualization with the laparoscope. The artery supplying blood and the duct or tube emptying the gallbladder are secured, and the gallbladder then removed. When indicated, the surgeon may elect to take an x-ray during the procedure to clarify that your remaining bile duct system is normal. Very complex problems may factor in and make the traditional or “open” type of gallbladder surgery necessary.

Chronic Abdominal Pain

This refers to people who have either continual or recurring episodes of pain that persist for more than three months. It is often associated with pelvic issues in women, but occasionally it may be related to abdominal adhesions (internal scar tissue). Surgery to divide these adhesions may improve the symptoms for some and is usually performed with laparoscopy if possible. If you have had prior surgery, the operative records may be very helpful in assessing your condition.

A surprisingly large number of people suffer from heartburn, or gastroesophageal reflux disease (GERD), many of them on a daily basis. There are many excellent medications available to treat the symptoms of heartburn and for most people this is sufficient. For some, however, chronic medical treatment is ineffective, incompatible with their lifestyle or contraindicated. For those people, there are surgical options that may provide an excellent alternative to medical therapy.
While the laparoscopic Nissen fundoplication has been the gold standard procedure for the treatment of GERD and it’s complications, there have been several even less invasive procedures advanced in the last decade. Only one, the Transoral Incisionless Fundoplication or TIF procedure, is now performed on an increasing basis around the country and abroad. This procedure is performed through the inside of the esophagus and stomach, and utilizes a device to create or tighten the valve at the lower end of the esophagus similar in appearance to the one created laparoscopically by wrapping the stomach around the lower end of the esophagus (Nissen fundoplication). The TIF procedure offers good relief from heartburn in most cases with minimal to no side effects. For those with large hiatal hernias (a condition where the stomach pushes up through an enlarged opening in the diaphragm), the laparoscopic Nissen fundoplication remains the standard approach at the present time. This procedure requires five small incisions (1/4-1/2 inch), an overnight stay, and about a two to three week recovery. It is very effective in alleviating heartburn and regurgitation, but does have some potential side effects such as bloating, a feeling of fullness more rapidly upon eating, and occasional difficulty in swallowing.

Surgery for gallbladder disease is one of the most common operations performed by general surgeons. Gallstones form when there is an imbalance in the various components of bile, a fluid made by the liver and secreted through the bile ducts into the intestine to aid in fat digestion. Some of the bile is stored in the gallbladder and is excreted in reaction to eating, particularly fatty foods. If a stone blocks the outflow of the gallbladder (the cystic duct), pain may occur until the stone dislodges or passes. If the stone blocks the common bile duct, pain, fever, and jaundice (yellow eyes, skin, dark urine) can result, and in some cases, inflammation of the pancreas gland (pancreatitis) may occur. These complications are much more serious and require immediate medical attention. For most people, however, the symptoms are repeated episodes of pain felt under the rib cage on the right side or just below the breast bone typically following a fatty meal. Nausea or vomiting are also common symptoms during an attack.

The most definitive treatment for gallbladder disease is to remove the gallbladder and gallstones within it. In the past, this was done through a large incision below the right rib cage. Since the early 1990′s, this surgery has been performed laparoscopically in all but a small percentage of cases. Since laparoscopy utilizes small incisions, it is generally much less painful than the open procedure and causes little to no disruption of the intestinal function (ileus). This leads to a much more rapid recovery, and, in most cases, allows you to go home the same day as your surgery. It may take a couple of weeks for your body to adjust to the absence of the gallbladder, but most people can resume a normal diet and activity level within that time frame. For more information about gallbladder disease and cholecystectomy, you can download About Cholecystectomy, a pamphlet prepared by the American College of Surgeons.

This type of hernia involves a defect in the abdominal wall that may be congenital or acquired following a prior operation. This latter type is called an incisional hernia. These hernias can be fixed either with an open incision or with laparoscopy. Both types of repairs utilize mesh to cover or secure the defect to prevent recurrence of the hernia. Open surgery may be required in certain situations, but laparoscopy offers a number of advantages, particularly in reduced would complications and lower recurrence rate. The goal of the operation is to clear the abdominal wall internally, separating the hernia contents from the defect in the abdominal wall and any other adhesions, and then to place a large piece of mesh under the abdominal wall to seal any and all defects. Occult (hidden) defects can be visualized better with laparoscopy and repaired along with the primary hernia to decrease the chance of needing another surgery later on. Frequently the laparoscopic repair can be performed as an outpatient procedure but you may also require a brief hospital stay if the repair is more complicated or you have additional medical problems.
For very large or multiply recurrent hernias, a component separation repair may be required to reconstruct the abdominal wall. This is a more involved operation, but it may be the best solution for the difficult abdominal hernia. Occult hernia defects may develop in time into larger defects that will require additional surgery.

Skin Diseases

General Surgeons frequently remove “lumps and bumps,” as well as deal with more advance skin tumors, such as melanoma. Some of these procedures can be done in the office under a local anesthetic if the lesion is small enough, but others are best done in an operating room. For tumors such as melanoma, lymph node removal may be indicated along with the wide removal of the primary tumor itself. We will work closely with your Dermatologist and/or Oncologist to determine if this is necessary in your case.

Colon Surgery

The colon or large intestine is the last portion of the intestinal tract its primary role is to absorb water and temporarily store waste material. The colon is divided into several segments based on the divisions of the blood vessels feeding it. These segments are the right colon, the transverse colon, the descending colon, the sigmoid colon and the rectum.

The indications for surgery on the colon are tumors, colon cancer or large precancerous polyps, infections such as diverticulitis and perforations, and bleeding from tumors, diverticulosis or abnormal blood vessels called arteriovenous malformations (AVM’s). Surgical removal of the colon is called a colectomy. Surgeons generally remove the segment (hemicolectomy or partial colectomy) that contains the tumor, infection or bleeding site. Other diseases such as ulcerative colitis and familial polyposis involve the entire colon and require a subtotal or total colectomy.

The colon is not essential and many people have their entire colon removed and lead a normal life. On rare occasions, the remaining colon or small intestine is attached to the skin on the anterior abdomen and drains into a bag, a colostomy. This is generally a temporary condition and a second operation can be performed to reattach the beginning part of the colon to the final part of the colon, the rectum, to return normal bowel function. If the distal rectum is the site of the disease, then the colostomy may be permanent.

Prior to surgery, patients must take a “bowel prep” that consists of a liquid diet, strong laxatives and antibiotic tablets over two days to reduce the bacteria in the colon to make surgery safer. This is generally done at home. Colon surgery requires a general anesthetic and takes from 1 1⁄2 to 3 1⁄2 hours. Patients generally need to stay in the hospital from 5 to 10 days after surgery and are fully recovered in 4 to six weeks.

In some circumstances, colon surgery can be preformed laparoscopically. In this case, a series of small incisions are made and a TV camera and long thin instruments are inserted into the abdomen. The identical surgery is then performed but without a large incision (opening) into the abdominal cavity. With the smaller incisions, the hospital stay and recovery period are shortened. This is a relatively new procedure and is used only in specific situations, but may be used more generally in the future as experience with the procedure around the world grows.

Pancreas

This is an organ that produces insulin (a hormone that regulates blood sugar levels) as well as digestive enzymes. It can be affected by various factors including excessive alcohol, gallstones, various medications, and hereditary conditions. It can also give rise to tumors, both benign and malignant. Pancreatic cancer is unfortunately a very aggressive cancer, but surgery offers the only potential to cure this disease in the appropriate setting. Surgery can also be used to palliate (relieve) symptoms related to advanced cancers. Endocrine tumors of the pancreas secrete hormones and in many cases may be removed in a less extensive manner. Cystic tumors of the pancreas (benign or malignant) may also require partial removal of the pancreas gland, but often have a better prognosis than pancreatic cancer.